Prostate Cancer in Kenya: Causes, symptoms, diagnosis and treatment

Prostate Cancer in Kenya: The prostate is a small gland in the pelvis found only in men. About the size of a satsuma, it’s located between the penis and the bladder and surrounds the urethra.

The main function of the prostate is to help in the production of semen. It produces a thick white fluid that is mixed with the sperm produced by the testicles, to create semen.

Prostate Cancer in Kenya: Causes of prostate cancer

It is not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.

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These include:

• Age – risk rises as you get older and most cases are diagnosed in men over 50 years of age.
• Ethnic group – prostate cancer is more common among men of African-Caribbean and African descent than in men of Asian  descent.
• Family history – having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it. Research also shows that having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer.
• Obesity – recent research suggests that there may be a link between obesity and prostate cancer.
• Exercise – men who regularly exercise have also been found to be at lower risk of developing prostate cancer.
• Diet – research is ongoing into the links between diet and prostate cancer. There is evidence that a diet high in calcium is linked to an increased risk of developing prostate cancer.

In addition, some research has shown that prostate cancer rates appear to be lower in men who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts.

Prostate Cancer in Kenya: Symptoms of prostate cancer

Prostate cancer does not normally cause symptoms until the cancer has grown large enough to put pressure on the urethra.

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This normally results in problems associated with urination. Symptoms can include:

• needing to urinate more frequently, often during the night
• needing to rush to the toilet
• difficulty in starting to pee (hesitancy)
• straining or taking a long time while urinating
• weak flow
• feeling that your bladder has not emptied fully

Many men’s prostates get larger as they get older due to a non-cancerous condition known as prostate enlargement or benign prostatic hyperplasia.

Symptoms that the cancer may have spread include bone and back pain, a loss of appetite, pain in the testicles and unexplained weight loss.

Diagnosing prostate cancer

If you have symptoms that could be caused by prostate cancer, you should visit your GP.

There is no single, definitive test for prostate cancer, so your GP will discuss the pros and cons of the various tests with you to try to avoid unnecessary anxiety.

Your doctor is likely to:

• ask for a urine sample to check for infection
• take a blood sample to test your level of prostate-specific antigen (PSA)
• examine your prostate (digital rectal examination)

PSA testing

PSA is a protein produced by the prostate gland. All men have a small amount of PSA in their blood, and it increases with age.

Prostate cancer can increase the production of PSA, and so a PSA test looks for raised levels of PSA in the blood that may be a sign of the condition in its early stages.

However, PSA testing is not a specific test for prostate cancer. Most men who have prostate cancer will not have a raised PSA level. More than 65% of men with a raised PSA level will not have cancer, as PSA levels rise in all men as they get older.

Digital rectal examination (DRE)

The next step is a DRE, which can be done by your GP.

During a DRE, your GP will insert a lubricated and gloved finger into your rectum. The rectum is close to your prostate gland, so your GP can check to feel if the surface of the gland has changed. This will feel a little uncomfortable, but should not be painful.

Prostate cancer can make the gland hard and bumpy. However, in most cases, the cancer causes no changes to the gland and a DRE may not be able to detect the cancer.

DRE is useful in ruling out prostate enlargement caused by benign prostatic hyperplasia, as this causes the gland to feel firm and smooth.

Biopsy

Your GP will assess your risk of having prostate cancer based on a number of factors, including your PSA levels, the results of your DRE, and your age, family history and ethnic group. If you are at risk, you should be referred to hospital to discuss the options of further tests.

The most commonly used test is a transrectal ultrasound-guided biopsy(TRUS). A biopsy may also be taken during a cystoscopy examinationor through the skin behind the testicles (perineum).

During a TRUS biopsy, an ultrasound probe (a machine that uses sound waves to build a picture of the inside of your body) is inserted into your rectum. This allows the doctor or specialist nurse to see exactly where to pass a needle through the wall of your rectum to take small samples of tissue from your prostate.

The procedure can be uncomfortable and sometimes painful, so you may be given a local anaesthetic to minimise any discomfort. As with any procedure, there may be complications, including bleeding and infection.

Although it is more reliable than a PSA test, the TRUS biopsy can have problems. It can miss up to one in five cancers, because the location of the cancer is unknown when it is carried out. The doctors can see the prostate using the ultrasound scan, but not the tumour(s) if they are present.

You may need another biopsy if your symptoms persist, or your PSA level continues to rise. Your doctor may request an MRI scan of the prostate before another biopsy.

Treating prostate cancer

Your treatment for prostate cancer will depend on your individual circumstances.

For many men with prostate cancer, no treatment will be necessary. Active surveillance or “watchful waiting” will mean keeping an eye on the cancer and starting treatment only if the cancer shows signs of getting worse or causing symptoms.

When treatment is necessary, the aim is to cure or control the disease so it doesn’t shorten life expectancy and affects everyday life as little as possible. Sometimes, if the cancer has already spread, the aim is not to cure it, but to prolong life and delay symptoms.

Prostate Cancer in Kenya: Your cancer care team

People with cancer should be cared for by a multidisciplinary team (MDT). This is a team of specialists who work together to provide the best care and treatment.

The team often consists of a specialist cancer surgeon, an oncologist (a radiotherapy and chemotherapy specialist), a radiologist, pathologist, radiographer and a specialist nurse. Other members may include a physiotherapist, dietitian and occupational therapist. You may also have access to clinical psychology support.